摘要
目的探讨卵巢功能评估指标对基础卵泡刺激素(bFSH)水平增高的人群体外受精(IVF)结局的预测价值。方法回顾性病例对照研究分析bFSH≥10 IU/L接受IVF/卵胞质内单精子显微注射-胚胎移植(ICSI-ET)治疗的患者505个周期。其中年龄<35岁者共171个周期,年龄≥35岁者共374个周期。2个年龄段者分别以抗苗勒管激素(AMH)≤1.1 μg/L或AMH>1.1 μg/L分为A(n=69)、B组(n=102)和C(n=248)、D组(n=86)。比较4组患者的基线资料、周期取消率、临床妊娠率、着床率、早期流产率,并对IVF周期是否取消周期和是否临床妊娠的影响因素行logistic回归分析。结果随着年龄的增长和AMH水平降低,高bFSH人群的IVF结局变差。对于年龄<35岁和≥35岁的患者在低AMH组(A组和C组)的取消周期率(因未取卵+获卵数为0+劣质胚胎)(31.88%,38.89%)均高于高AMH组(B组和D组)(18.63%,P=0.046;10.47%,P=0.001),差异均有统计学意义;临床妊娠率(38.89%,25.93%)与高AMH组(62.26%,38.46%)比较,差异无统计学意义(P>0.05),但有降低趋势;早期流产率(14.28%,42.85%)均高于高AMH组(6.10%,P=0.437;0,P=0.027),并在高龄患者中差异显著。进一步回归分析显示:该周期是否取消周期与bFSH值呈正相关,与窦卵泡计数(AFC)呈负相关;仅年龄与IVF新鲜周期的临床妊娠率呈负相关。结论年龄和AMH是影响高FSH人群IVF结局的因素,可用以指导临床。而联合AFC和bFSH对取消周期有预测作用,年龄对新鲜移植周期的临床妊娠结局有良好的预测作用。
ObjectiveTo explore the predictive value of ovarian reserve markers for people with increased basic follicle stimulating hormone (bFSH) levels in in vitro fertilization (IVF) outcomes.MethodsA retrospective analysis of 545 cycles of patients with bFSH≥10 IU/L receiving IVF/intracytoplasmic sperm injection-embryo transfer (ICSI-ET) treatment was performed. Patients in 171 cycles were <35 years old and patients in 374 cycles were≥35 years old. They were divided into group A (n=69) or group B (n=102) and group C (n=248) or group D (n=86) according to anti-Müllerian hormone (AMH)≤1.1 μg/L or AMH>1.1 μg/L, respectively. Baseline data, cycle cancellation rate, clinical pregnancy rate, implantation rate and early abortion rate were compared among these 4 groups. Logistic regression analysis was performed to determine the correlation between ovarian reserve markers and cycle cancellation and clinical pregnancy.ResultsWith the increase of age and AMH, IVF outcomes decreased in the high bFSH population, retrieved oocytes and available embryos decreased also. In low AMH groups (group A, group C), the cancellation rates of the IVF cycles (due to not get eggs and no oocyte retrieval and poor-quality embryo) (31.88%, 38.89%) were higher than those in high AMH groups (18.63%, P=0.046;10.47%, P=0.001), the difference was significant;the clinical pregnancy rates (38.89%, 25.93%) were lower than those in high AMH groups (62.26%, 38.46%) with no significant differences (P>0.05);the early abortion rates (14.28%, 42.85%) were higher than those in high AMH group (6.10%, P=0.437;0, P=0.027). It was found that bFSH value was positively related to whether the cycle was cancel, while the antral follicle count (AFC) was negatively related to whether the cycle was cancel. Only the age was negatively related to the clinical pregnancy rate of IVF fresh cycle.ConclusionThe age and AMH level are factors affecting IVF outcomes in patients with high level of FSH, which can be used to guide the clinical practice. Joint of AFC and bFSH to cycle cancellation, and age to fresh transplant clinical pregnancy have good prediction effects.
作者
王雪
李秋圆
张少娣
赵华
张翠莲
Wang Xue;Li Qiuyuan;Zhang Shaodi;Zhao Hua;Zhang Cuilian(Reproductive Center of Henan Province People's Hospital,Zhengzhou 450000,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2018年第12期1009-1012,共4页
Chinese Journal of Reproduction and Contraception
基金
国家自然科学基金项目(81701444).
